Preparing for Colorectal Surgery
Colorectal surgery encompasses a wide range of procedures involving the anus, rectum and small and large intestine. Some are performed on an outpatient basis with local anesthetics or sedation, while others take place in the hospital’s operating room (OR) under general anesthesia.
In what follows, Dr. Lea Lowenfeld, a colorectal surgeon and an Assistant Professor of Surgery in the Division of Colon and Rectal Surgery at Weill Cornell Medicine, provides answers to your FAQs regarding the conditions that require surgical treatment, the procedures surgeons perform and the steps patients need to take to prepare for surgery, from minor surgical “fixes” to major operations.
Outpatient procedures
Smaller procedures don’t always require preparation, Dr. Lowenfeld says. They may be performed in the doctor’s office, and patients are awake throughout.
Outpatient (office-based) procedures include:
- Removing small skin tags around the anus
- Rubber banding internal hemorrhoids
- Injecting botox to heal a fissure
- Draining an abscess
At most, the surgeon will use lidocaine—a topical anesthetic—to minimize any discomfort.
A colonoscopy or sigmoidoscopy, which is an abbreviated version of a colonoscopy that visualizes only the lower segment of the intestine, can be done in an endoscopy suite under light anesthesia. “Your doctor will give you instructions on how to prepare for these,” she adds, “and you’ll be able to go home an hour or two afterwards, once you’re fully awake and alert.”
Make sure to have someone pick you up after any procedure involving sedation or anesthesia. That’s a must!
Inpatient procedures
These include larger operations involving the removal of all or part of the colon—a procedure called a colectomy. Patients with the following conditions may require a partial or total colectomy:
- Inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn’s disease
- Colon cancer
- Rectal cancer
- Recurrent diverticulitis that hasn’t responded to other types of treatment
The main issue, says Dr. Lowenfeld, is anesthesia safety. “That’s why you’ll need to stop eating solid food the night before and stop taking liquids 2 hours before sedation.”
More extensive surgical procedures may also require patients to stop taking blood-thinning medications before surgery, and that includes colorectal surgery. But baby aspirin is usually okay, she says. It’s important to discuss all your medications with your doctor and review which, if any, should be stopped prior to surgery.
The information you’ll need to provide
Don’t forget to provide the hospital with the following information:
- Your allergies, if any
- The medications you take
- Your pharmacy’s location and contact information
Just in case, please also include your “advance directive,” defined by the National Institute on Aging as a legal document containing instructions for medical care that go into effect if you can’t communicate your own wishes. An advance directive is also called a “living will.”
Your hospital stay
What to bring
Bring a list of your medications, but no need to bring the pills themselves, as the hospital pharmacy has most medications. The only exceptions may be very specific creams, eye drops or pills, says Dr. Lowenfeld.
And bring anything that makes you feel more comfortable, whether a favorite pillow, body lotion or your preferred foods and beverages (but no alcohol, of course!).
After surgery
- You’ll start to eat and drink shortly after you’re awake.
- After a colectomy, a patient will usually need to stay in the hospital from 2 to 5 days.
- Your intestines may be a bit sluggish at first.
- The hospital staff will get you back on your feet as soon as possible, even on day 1 after surgery.
Before you’re discharged
There are several criteria that need to be met before you can be discharged from the hospital, she says: “You’ll need to resume eating and drinking enough for adequate nutrition and hydration, and you’ll need to experience a return of bowel function. And your pain, if any, will need to be well controlled.”
Recovering at home
Once you’re home, “we encourage you to get back to your normal routines as soon as you’re able,” she adds.
And as for home care, that depends on your needs. If you’re independent before surgery, chances are you won’t need extra help at home. But it’s always good to have someone there for a while, whether a family member, a friend or a professional to help you take a shower or deal with wound care.
“If there are wound care needs, we can set you up with a visiting nurse,” says Dr. Lowenfeld. “Just ask to speak with a social worker, and they’ll get in touch with the Visiting Nurse Service.”
If you have further questions about colorectal surgery, don’t hesitate to visit here to learn more.